Stroke and TIAs (Transient Ischaemic Attacks)

Stroke is the third most common cause of death after heart disease and cancer. While you may be aware of the symptoms of a heart attack and the importance of calling 999 if you suspect one, do you know that a stroke is the equivalent of a ‘brain attack’ and so requires prompt action too?

Here we explain how to recognise the symptoms and what to do if you think someone is having a stroke. We also look the causes of a stroke, treatment and support available to help you after a stroke and suggest where you can go for more specialist information and support.

You can also learn more about how your lifestyle affects your chance of having a stroke and steps to take to reduce your risk of having one.

What is a stroke?

A stroke is caused when the blood supply to your brain is cut off or reduced. As a result, brain cells are deprived of oxygen and other nutrients in the blood and this quickly causes damage or death to cells in parts of the brain.

There are two types of stroke:
Ischemic stroke – this is caused when a blood clot blocks a main artery in your brain. Around 17 out of 20 strokes are of this type.

Haemorrhagic stroke – this is caused when a weakened artery in your brain bursts. This allows blood to seep out and press on your brain. It also prevents blood and oxygen reaching other parts of the brain.

The effects of a stroke depend on:

• how long your brain is deprived of oxygen
• whereabouts in your brain the artery becomes blocked and
• the functions of the affected part of the brain.

A ‘mini’ stroke or to use its medical term - transient ischemic attack (TIA) has similar symptoms to a stroke but they may last only a few minutes or hours and disappear completely within 24 hours. However don’t ignore this, as it may be a warning sign of a more serious stroke to come.

Could you be at risk?

There is no single underlying cause of stroke. There are some things that increase your risk of a stroke that you can’t change. These are known as ‘non-modifiable’ risk factors and include:

• having had a ‘mini’ stroke
• increasing age
• being of South Asian, African or African Caribbean origin
• having a relative who has had a stroke and
• having a condition such as diabetes or heart disease.

But others, known as ‘modifiable risk factors’, you can do something about and so lower your risk. These and include:

• high blood pressure
• high cholesterol
• smoking – this doubles your risk and giving up cuts that risk dramatically no matter how long you have been a smoker or how old you are.
• drinking alcohol – too much alcohol, particularly binge drinking, as this can raise your blood pressure
• lack of regular physical activity – which has a negative effect on your blood pressure, cholesterol and weight
• eating an unhealthy diet – generally one too high in calories, fat and salt and doesn’t include at least 5 portions of fruit and vegetables a day.

Can you reduce your risk?

You should make an appointment to see your GP if any of these risk factors apply to you – particularly if your family background puts you at greater risk. By identifying your overall risk of a stroke, you can discuss how to lower your risk of and agree an action plan.

If you have had a stroke or a mini stroke you are more likely to have another, so you need to agree with your doctor how best to reduce your future risk. This usually includes targeting the risk factors identified above.

Helping you make lifestyle changes

You can use the lifestyle quizzes and checklists on the NHS Choices website to see how closely you are to meeting current guidelines on eating, physical activity and exercise. You’ll also find tips on how to fit any changes into your daily routine.

The Stroke Association also offers help and advice on lifestyle changes.

These suggestions can help you on your way:

• If you smoke, take steps to stop. This is the most significant change you can make. The difficulties of giving up smoking are well known, so ask your GP or practice nurse how the NHS can help you. You may have the choice of one-to-one sessions or joining a local group so you can share experiences and tips with others who are trying to give up. Nicotine products and other medication are available on prescription. You may prefer to look on the NHS Smokefree website for more information or call their helpline for advice.
• Check out your diet? – it should be one that has plenty of fruit and vegetables, plenty of starchy foods such as bread and potatoes and is low in sugar, salt and fat, particularly saturated fat.
• Do you drink too much? – although some research suggests some alcohol might be good for your heart, binge drinking and drinking more than the recommended units each week is not. Drinkline is the national alcohol helpline.
• Do you take enough regular exercise? – aim for activities that you enjoy, are relatively easy to build into your daily routine and that make you feel slightly breathless but do not cause pain or discomfort. Building up to 30minutes on 5 days a week is recommended. As well as increasing your fitness, it can help control your weight, blood cholesterol and blood pressure.

Recognising symptoms

The FAST test
The first signs of a stroke can be very sudden. Applying the FAST test can indicate whether the symptoms you are observing suggest the person is having a stroke or TIA:

Facial weakness – can the person smile? Has their mouth or eye drooped?
Arms – can the person raise both arms?
Speech problems – can the person speak clearly and understand what you say?
Test all three.

If the person fails one of these tests you need to act FAST and call 999 for advice. Ambulance staff are trained to assess people with a suspected stroke and get them to an appropriate hospital for tests and urgent treatment. The sooner you receive appropriate treatment, the better your chances of a good recovery.

Diagnosis and treatment

Diagnosis

On arrival at A&E, diagnosis of a stroke or TIA should be confirmed.

Once confirmed, it is necessary to find out what type of stroke you’ve had before starting treatment - bleeding into your brain (a haemorrhagic stroke) may need different treatment to one caused by a blocked artery (an ischaemic stroke).

Doctors can do this by arranging a scan that produces an image of your brain and shows where the damaged area is and what damage has been done. This might be a CT (computed tomography) scan or a more detailed MRI (magnetic resonance imaging) scan. You should have a scan within 24 hours if doctors think you've had a stroke.

Early and longer term treatment after a stroke

Each part of the brain has specific functions although the different parts also work together. How a stroke affects you, will depend on:

• the type of stroke you’ve had
• how bad it was and
• which parts of your brain are affected.

Brain cells can’t grow back but the brain has a remarkable ability to recover and parts of the brain can develop new connections. Therefore there could be potential for another part of the brain to take over some of the functions of the damaged parts. This is a gradual process that may take months or even years. Therefore it’s difficult to know whether symptoms evident in the first few days will remain several months later.

Some common effects of a stroke are:

• weakness or paralysis on one side of your body
• difficulty swallowing (known as dysphagia)
• problems talking coherently and with reading and writing
• problems with bladder and bowel control
• memory problems and difficulty concentrating
• problems with your vision

If a relative is admitted to hospital with a suspected stroke, you may want to ask if the hospital has to a specialist stroke unit. Here you are cared for by a range of experienced health professionals - doctors, nurses, physiotherapists, occupational therapists and speech therapists - whose main job is to care for people who have had a stroke and stimulate their recovery.

Staff on a stroke unit follow what is known as a ‘care pathway’, this ensures your condition is thoroughly assessed and closely monitored and you get all the treatment you should - according to your agreed care plan - from a wide range of health professionals.

The aim of your treatment and rehabilitation programme is to help you regain, where possible, the abilities you lost as a result of the stroke and to help you and your carers adapt to life afterwards. The care pathway approach gives you the best chance of a good recovery.

Some hospital wards although not designated specialist units, follow the care pathway approach and have access to specialist staff.

You may be on a hospital unit or ward for a couple of weeks after a stroke and then move into another ward or another location for further rehabilitation.

Treatment of a TIA

Whether your symptoms prompt you to go to hospital or because the symptoms passed quickly, you opt to make an appointment with your GP, it is important to assess your future risk of a stroke and take appropriate action. What should happen if you have a suspected TIA is explained in the NICE guidance mentioned below.

Help and support following a stroke

The long term effects of a stroke vary from person to person. Nevertheless is a major event in anyone’s life and the emotional consequences can last for many months. A range of emotions - anger, anxiety and frustration – are common and it is important to seek help if you find it difficult to cope.

The health professionals and social care staff involved in your care also recognise this and can discuss and agree with you, the support you need to regain your confidence, make daily living easier and regain as much independence as possible.

If your partner will be providing support when you come home, they are entitled to a carer’s assessment. This can identify any help they need to care for you.

The Stroke Association has a comprehensive website, a wide range of publications that address the medical, emotional and practical consequences of having a stroke. They also have a telephone helpline and local Life After Stroke services. These may vary across the country but aim to offer practical help and a chance to meet other families whose lives have been touched by a stroke. You can find out more from their website or by calling the helpline.

Financial support

If you need help with personal care or watching over to make sure you are all right, you may be eligible to claim a non means tested benefit – Disability Living Allowance if you are under 65 or Attendance Allowance if you are 65 and over.
Find out more about benefits

NHS Inform website:
www.nhsinform.co.uk
You can find information about stroke – risk factors, symptoms and treatment in the Health A-Z section.

The Stroke Association
www.stroke.org.uk

Helpline 0845 303 3100 (lo-call rate)
The Stroke Association is the only UK charity solely concerned with combating stroke in people of all ages.